2013-155 TOWN OF QUEENSBURY
Road,Queensbury,NY 12804-5902 (518)761-8201
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742 Bay Q rY
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130155 Date Issued: Monday, April 29, 2013
This is to certify that work requested to be done as shown by Permit Number P20130155
has been completed.
Tax Map Number: 523400-296-013-0001-074-000-0000
Location: 77 MONTRAY Rd
Owner: JOHN W HOLT
Applicant: JOHN W HOLT
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the _ . .-
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
A.h4
'� 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
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Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130155 Application Number: A20130155
Tax Map No: 523400-296-013-0001-074-000-0000
Permission is hereby granted to: JOHN W HOLT
For property located at: 77 MONTRAY Rd
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: JOHN W HOLT Septic Alteration Residential
LOU ANN HOLT Total Value
77 MONTRAY Rd
QUEENSBURY NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2013-155
Res. Septic alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,April 23,2014
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the To n of eens /J es�i. pril 23,2013
SIGNED BY \ for the Town of Queensbury.
Director of Building&Code Enforcement
APR 2 2 2013
lb--
-,S< Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only • -
_
TAX MAP NO. a�4 +� 1r r PERMIT NO.J)iLD o�� PERMIT FE S
I
APPROVALS: ZONINGTOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM ERMIT: A PERMIT MUST BE OBTAINED
BEFOREWOBEGI S. APPLICATION I SUBJECT TO REVIEW FORE ISSUANCEI " A VALID P RMIT.
OWNER V ✓ IQ ./.0.../ A�rtf Cr INSTALLER: i/ 4/2'7 QG��'w /�w
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ADDRESS: 77 AI o/J / S/
e/ ADDRESS: v O Q�e)-y ‘
PHONE NOS. 7 7 2 -9$o PHONE NOS. 7 % --0 P.5.3
LOCATION OF INSTALLATION: 7 7 /(1 DPI/R 4--i 6-7D
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDV2,
1980 or older c) X 150 = i CI O INSTALLED? f J C'
1981 -1991 X 130 = SPA OR HOT TUB N
1992-present X 110 = INSTALLED? v
PARCEL INFORMATION:
/ TOPOGRAPHY: FLAT ROLL STEEP SLOPE___ %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WI—i EPTH?___ _
v. DOMESTIC WATER SUPLY: MUNICIPAL V/ WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS_ _PER MIINUTE PER INCH[mpi] (Test to be completed by a licensed professional
engineer or architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed professional engineer or
architect(unless installedin a Planning ao,ard approved subdivision).
TANK SIZE: c) GALLON (MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa or whirlpool tub.
SYSTEM TYPE:
❑ABSORPTION FIELD (WITH NO.2 STONE) Total length ft. Each trench X _
❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size?
f ALTERNATIVE SYSTEM ed r other type?a c7 r X C4 3
❑ HOLDING TANK SYSTEM Total required capacity? Tank size? _Number of tanks? __
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL
INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury,any permit or approval
granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a material fact or
circumstance known by or on behalf of an applicant,shall be void.
read the r-•u : ions with re •ect to this application and agree to
ide y these -id a -gull-ern:7 of the Town of Q Bens ry QUESTIONS? CALL 7614256 OR EMAIL
an. ry Sew.•r- D..••.al O • nce. codes(a�queensburV.net
i ature o P �n Responsible e4/'
� VISIT OUR WEBSITE FOR MORE INFORMATION
9 www.queensbury.net
l,J acbnesdatt 1.'eal
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection requ: - ed:
Queensbury Building &Code Enforcement Arrive: a '/p, separt: //. am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials• A.d
NAME: '//D PE1IT NO.: / 3- T.-
LOCATION: 7' 674-f-y c d IN•ECT ON: 9 -4/3
RECHECK:
Comments and/or diagram
Soil Type: S. •i / Loam/ Clay
Type of Water: .• ..► Well Water
Waterline separation distance _ ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO]
Absorption Field: Total length I w
Length of each trench ft.
Depth of trenches ft.
Size of Stone 2
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type _'- t /c . `_ ��
Building to tank -�.� .. �"''`
Tank to Distribution Box
Distribution Box to Field/ Pit ►'c � „�-�
4
Opening Sealed: N
End Cap � _
Inlet/Outlet Pipes&Baffles
Manholes 12"or less below grade _Y N
[provide extension collar if Yes] _Y
Location/ Separations
Foundation to tank ft.
Foundation to absorption "- ft.
Separation of Pits AJ ft.
Conforms as per Plot Plan _N
Engfneer-Re}3eft,and As-Built Y N
ETU Maintenance Contract Y N
provided
Location of SyF _- ' operty:
Front Rear eft Side Right Side Middle Front Middle Rear
S stem Use Sta ,.
Approved
• - • .pproved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report_03 29 10.doc
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SIGNAT 'E
APF; 2 2 2013
•
CENTER PROJECT
SERVICES
73 Sheridan Street, Glens Falls,NY 12801
Phone-518-796-2515
April 20,2013
Project# 168
Dan Drellos
Sanitary Sewer Services
Luzerne Road
Queensbury,NY 12804
Re: Proposed Replacement Septic
Holt Residence—77 Montrey Road, Queensbury, N Y
Dear Dan:
At your request we have reviewed your proposed replacement septic system design at the site of
the existing 2 bedroom house of at 77 Montrey Road in Queensbury. As per our conversation the
residence has an existing failed septic system.
We have reviewed the proposed replacement septic system design and we agree that a standard
absorption bed is acceptable. Based upon a design flow rate of 300 GPD and a percolation rate of
1 to 5 minutes, you will need 315 square feet of absorptive area. We recommend using a 20 ft
wide by 20 ft long absorption bed with 4 — 15 foot long laterals, which will provide 400 sf of
absorptive area. The absorption bed can be constructed with the existing 1,000 gallon septic tank,
new distribution box, and 4 inch diameter perforated pipe and stone.
Please feel free to contact me at 796-2515 if you have any questions and that you for your
assistance with this request.
Sincerely,
Digitally signed by Thomas Center Jr.
Thomas ON:cn=Thomas Center Jr.,o=Center
Project Services,ou,
Center Jr. email=tcenter36@yahoo.com,c=US
Date:2013.04.21 14:1559-04'00'
Thomas R. Center Jr, P.E.